Inside Health

By TERRY PRISTIN

Published: November 24, 2004

When the Northridge earthquake devastated Los Angeles County in 1994, St. John's Health Center, a private Catholic hospital in this seaside community, suffered such extensive damage that an entire wing had to be torn down. The most severely damaged of the 23 hospitals that had to suspend some or all services after the quake, St. John's was forced to close for nine months.

In early December, however, St. John's will begin admitting patients to a sleek new arc-shaped building that is designed to withstand an earthquake with twice the force of Northridge, which had a magnitude of 6.7. The new four-story North Pavilion, expected to cost more than $315 million, is part of a 15-year construction program that is intended to modernize the 62-year-old hospital, give it a more efficient layout that will be easier to navigate, and provide patients with some of the comforts of an elegant hotel.

The new building has light-filled private rooms equipped with 42-inch plasma television sets and upholstered window seats that allow visitors to nap or stay overnight. Nurses' stations are scattered throughout the floor to be closer to the rooms.

A multibillion-dollar hospital construction boom is under way in this state, a response to new seismic safety building codes and deadlines established in the aftermath of the earthquake. In 2001, state officials found that 40 percent of the state's 479 hospitals were in danger of collapsing in a major earthquake and 75 percent did not have adequate bracing to keep their mechanical and other systems operating.

In the 1994 earthquake, most of the serious damage occurred at hospital buildings constructed before 1971, when an earthquake centered in Sylmar, Calif., destroyed a newly built hospital and led to the first tightening of seismic standards.

Initially, the seismic legislation required all acute-care inpatient buildings that would be at risk during a strong earthquake to be rebuilt, retrofitted or closed by 2008, but hospitals may now apply for extensions up to 2013, and about one-third have already done so, said Kurt A. Schaefer, a deputy director of the Office of Statewide Health Planning and Development, which has approval power over the building plans. By 2030, however, all hospitals in the state must be not only structurally sound but also be able to care for patients after a disaster.

Rather than embark on costly retrofitting, many hospital administrators determined that it made more sense to rebuild from scratch, particularly if federal disaster help was available. Officials of the California Healthcare Association, the hospital industry's trade organization, once estimated that the state's rebuilding program would cost $24 billion. Now the group says the price tag will be much higher, in part because of the rising cost of building materials.

To some extent, the frenzied pace of hospital construction in California mirrors a national trend. ''This is the strongest health care construction market I've ever seen,'' said Robert D. Levine, the manager of the Turner Construction Company's national health care group; Mr. Levine has spent 40 years in the business. Turner is currently engaged in 125 medical projects -- including a $400 million joint venture with URS, a construction services company with headquarters in San Francisco, for work at U.C.L.A. -- twice the volume of five years ago. Mr. Levine said health care projects are helping to offset the nationwide slowdown in office construction and accounted for 17.2 percent of his company's business in 2003, compared with 8.8 percent in 1999.

Low interest rates and the aging stock of hospital buildings have helped fuel this growth spurt. Many hospital buildings date to the wave of hospital construction in the two decades after World War II and are not well suited to today's technology. Today's operating rooms, for example, have to be one-third larger than they were before, Mr. Levine said. With baby boomers also aging, many new hospitals are anticipating a growing demand for health care. And many are also moving to the suburbs from urban neighborhoods.

No state is building as many replacement hospital buildings as California, where architecture and design firms, construction companies and subcontractors are being stretched to the limit, real estate specialists say.

Construction companies are teaming up to minimize the risk that goes with developing complex projects costing hundreds of millions of dollars. Steve Mynsberge, a senior vice president for health care for the McCarthy Building Companies, said his company, which is based in St. Louis, is involved in 10 hospital projects in California. Among them is a $498 million joint venture with the Clark Construction Company of Costa Mesa and Hunt Construction Group of Phoenix to construct four buildings at the Los Angeles County and University of Southern California Medical Center.

Officials of the Office of Statewide Health Planning and Development said they did not know just how many new hospital buildings were planned. ''We're definitely at historic levels in terms of workload,'' said Paul A. Coleman, the deputy division chief for Los Angeles and Orange Counties.